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General NPI Number Information
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NPI Number | 1477616266
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Entity Type | Organization
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Legal Business Name | STRATEGIC REHABILITATION SERVICES, P.C.
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | STRATEGIC REHABILITATION SERVICES, P.C. 495 IRON BRIDGE RD.
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City | FREEHOLD
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State | NJ
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Zip | 07728
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Country | US
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Telephone | 732-780-8477
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Fax |
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Provider Business Mailing Address
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Address Line | STRATEGIC REHABILITATION SERVICES, P.C. P.O. BOX 190
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City | TENNENT
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State | NJ
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Zip | 07763-0190
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Country | US
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Telephone | 732-780-8477
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EVANDER DUCK JR.
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Credential | M.D. M.S.
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Telephone | 732-780-8477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA060290
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License Number State | NJ
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